What to do in psychotic illness

This is one of those times when the church should not try to mange things, but should look to the NHS for help. God has blessed us with this amazing resource, who have not only the expertise but also the hospitals that may be needed. However, the church still has a huge and equal role – in providing support, community, friendship and prayer. Psychotic illnesses include schizophrenia, bipolar affective disorder and drug-induced psychosis.

First Signs

These illnesses usually start slowly – with hindsight symptoms have often been grumbling for some months, even years. There may be others in the family who have the illness. It can start with social withdrawal, brief episodes of odd behaviour or sudden mood swings. Eventually, delusions and hallucinations will occur [in schizophrenia] or majorly elated mood [in bipolar affective disorder]. The picture can be clouded with alcohol and drugs that the person is using to control things. Part of the illness is ‘lack of insight’ – an inability to see that this could be due to a brain disorder.

How to get help

Sadly, most psychotic illnesses first get help when the person is admitted to hospital. This can be a difficult time with escalating behaviour, substance misuse and a lack of insight by the person affected. If someone is very unwell and in need of urgent help, the best thing to do is persuade them to go straight to A&E. If they refuse and there are significant risks, you should call the police. The person may resent this, but you should explain that you had no choice given the circumstances.

It is preferable to keep the person out of hospital. Even rapid presentations can be sometimes be managed at home – most parts of the UK have Home Treatment Teams. Your GP is the first port of call – without the person concerned for the first appointment if need be – and they can make a referral to the local mental health service. Assessment appointments can be scheduled as needed – urgently if the situation is extreme. The Mental Health Act [a provision for compulsory powers] can be used by the GP or [more usually] a psychiatrist if the person lacks insight.

What happens at the hospital?

The first contact with mental health services will be a mixture of trying to understand the story and doing a risk assessment. Ideally the person will be persuaded of the need to seek help, however choices may have to be made for them. Outpatient care or Home Treatment will be the preference. If hospital is needed, expect the person to be in hospital for some weeks and to be discharged slowly [with passes] and a good package of community support.

Medication is a core part of treatment, as this reduces the symptoms and helps the return of insight – however it is not everything. Support for family and friends, physical exercise, personal belongings and spiritual care are also important – and should be offered. In time. A keyworker and talking treatments should also be discussed.

What can the church do?

This is a scary time – the rest of the church community can feel out of their depth. However, good mental health services realise the importance of the wider community. Prayer is tremendously important and it is as times like this we realise the power of prayer. Care for the rest of the family is also important.

If the person is in hospital visiting or sending cards or flower is vital – many psychiatric patients receive nothing – which is amazing when you consider what most other hospital inpatients get. If the problem is more chronic and it takes them some time to get well, do not drift away or abandon hope – this is exactly when on-going support is needed.

What if things are moving too slowly?

There are always people you can speak to. Ask to talk to the doctor or nurse. If you are a significant part of the person’s life, you are entitled to be involved in discussions about future care under the Care Programme Approach. Most NHS services have arrangements with Advocacy Services and Carers Services who can support people who are struggling to make their views hear. If all else fails, your MP or MSP may be able to help.